Endovascular therapy (EVT) is a type of minimally invasive surgery carried out within the blood vessels. According to research, it is 2.5 times more effective than traditional medical treatment in achieving favorable results after vertebrobasilar strokes, which affect the back part of the brain, including the brain stem. This conclusion comes from a meta-analysis of four randomized clinical trials, directed by Raul Nogueira, M.D., of the UPMC Stroke Institute, and published today in The Lancet.
A collaborative team from the U.S., Netherlands, and China reviewed data from all four randomized trials related to EVT for vertebrobasilar occlusion. Their findings highlight the significant advantages of EVT compared to other methods for tackling complex blockages in critical brain areas.
Vertebrobasilar artery blockages, which disrupt blood flow in the back of the brain, represent a small portion of all ischemic strokes but are especially fatal. Without timely intervention, these strokes can lead to severe disabilities or deaths, with rates that can exceed 70%.
“While the clear benefits of EVT for acute ischemic strokes caused by blockages in large vessels supplying the front part of the brain are well-known, the advantage of this procedure for vertebrobasilar artery occlusions—one of the most tragic stroke types—has been debated,” stated Nogueira, who holds a professorship in neurology and neurosurgery at the University of Pittsburgh.
To clarify this uncertainty, the research team, known as VERITAS, aimed to provide clearer, more detailed, and statistically sound estimates of EVT’s effectiveness, particularly focusing on specific patient groups of interest.
The Pitt research team acted as the primary coordinating center, establishing standardized variables, definitions, and trial protocols that formed a foundational pooled dataset derived from four randomized controlled clinical trials: ATTENTION, BAOCHE, BASICS, and BEST, assessing EVT for strokes caused by vertebrobasilar artery occlusion.
The meta-analysis revealed that, three months after the procedure, EVT significantly decreased patient mortality and overall post-stroke disabilities, leading to greater functional independence for those treated. Remarkably, patients who underwent EVT were nearly 2.5 times more likely to regain independent walking ability compared to those receiving conventional medical care, including intravenous thrombolytics.
“The findings from the VERITAS collaboration are anticipated to shape treatment guidelines and enhance stroke care worldwide,” Nogueira noted. “Our hope is that this analysis paves the way for improved recovery outcomes following vertebrobasilar strokes and helps more individuals regain independence after such traumatic medical events.”
Additional authors of the study include Tudor Jovin, M.D., from Cooper University; Xinfeng Liu, M.D., Wei Hu, M.D., and Chunrong Tao, M.D., all from the University of Science and Technology of China; Chuanhui Li, M.D., and Xunming Ji, M.D., both affiliated with Xuanwu Hospital of Capital Medical University, China; and Wouter Schonewille, M.D., of St. Antonius Hospital, Netherlands, among others. The VERITAS collaboration is self-funded.
